Claims & Billing Analyst

We are seeking a Claims & Billing Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Claims & Billing Analyst plays an essential role in ensuring the accuracy and efficiency of healthcare billing and claims processing within the organization. This position is responsible for analyzing, reviewing, and resolving complex billing issues to optimize revenue cycle management. The Claims & Billing Analyst collaborates closely with healthcare providers and internal departments to verify claims, identify discrepancies, and facilitate timely reimbursements. By maintaining compliance with healthcare regulations and payer policies, the role helps minimize denials and delays in payment. Ultimately, the Claims & Billing Analyst contributes to the financial health of the organization by ensuring that claims are processed accurately and efficiently.

Minimum Qualifications:

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field.
• Minimum of 2 years of experience in medical billing, claims processing, or revenue cycle management.
• Strong knowledge of healthcare billing codes, insurance claim procedures, and payer guidelines.
• Proficiency with billing software and electronic health record (EHR) systems.
• Excellent analytical, problem-solving, and communication skills.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Preferred Qualifications:

• Master's degree in Healthcare Administration, Business, Finance, or a related field.
• Certification such as Certified Professional Biller (CPB) or Certified Coding Specialist (CCS).
• Experience working with Medicare, Medicaid, and private insurance claims.
• Familiarity with healthcare compliance standards such as HIPAA and the Affordable Care Act.
• Advanced skills in data analysis and reporting tools.
• Prior experience in a healthcare provider or insurance company environment.

Responsibilities:

• Demonstrates commitment to Our Mission and models ILS Experience Standards of Excellence.
• Review and analyze healthcare claims for accuracy, completeness, and compliance with payer requirements.
• Investigate and resolve billing discrepancies and denials by coordinating with providers, payers, and internal teams.
• Prepare and submit claims to insurance companies and follow up on unpaid or rejected claims to ensure timely reimbursement.
• Maintain detailed records of claims processing activities and generate reports to track performance metrics and identify trends.
• Stay current with changes in healthcare billing regulations, payer policies, and industry best practices to ensure compliance.
• Performs other duties as assigned.